Early and late patient outcomes in urgent-start peritoneal dialysis

See, Emily J., Cho, Yeoungjee, Hawley, Carmel M., Jaffrey, Lauren R. and Johnson, David W. (2017) Early and late patient outcomes in urgent-start peritoneal dialysis. Peritoneal Dialysis International, 37 4: 414-419. doi:10.3747/pdi.2016.00158


Author See, Emily J.
Cho, Yeoungjee
Hawley, Carmel M.
Jaffrey, Lauren R.
Johnson, David W.
Title Early and late patient outcomes in urgent-start peritoneal dialysis
Journal name Peritoneal Dialysis International   Check publisher's open access policy
ISSN 0896-8608
1718-4304
Publication date 2017-07-01
Year available 2016
Sub-type Article (original research)
DOI 10.3747/pdi.2016.00158
Open Access Status Not yet assessed
Volume 37
Issue 4
Start page 414
End page 419
Total pages 6
Place of publication Milton, ON, Canada
Publisher Multimed
Language eng
Abstract Background: Significant interest in the practice of urgent-start peritoneal dialysis (PD) is mounting internationally, with several observational studies supporting the safety, efficacy, and feasibility of this approach. However, little is known about the early complication rates and long-term technique and peritonitis-free survival for patients who start PD urgently (i.e. within 2 weeks of catheter insertion), compared to those with a conventional start.
Formatted abstract
Background: Significant interest in the practice of urgent-start peritoneal dialysis (PD) is mounting internationally, with several observational studies supporting the safety, efficacy, and feasibility of this approach. However, little is known about the early complication rates and long-term technique and peritonitis-free survival for patients who start PD urgently (i.e. within 2 weeks of catheter insertion), compared to those with a conventional start.

Methods: This single-center, matched case-control study evaluated patients commencing PD between 2010 and 2015. Urgent-start PD patients were matched 1:3 with conventional-start PD controls based on diabetic status and age. The primary outcomes were early complications, both following catheter insertion and PD commencement (within 4 weeks). Secondary outcomes included technique and peritonitis-free survival.

Results: A total of 104 patients (26 urgent-start, 78 conventional-start) were included. Urgent-start patients were more likely to be referred late, initiate PD in hospital, and be prescribed lower initial exchange volumes (p < 0.01). They experienced more frequent leaks post-catheter insertion (12% vs 1%, p = 0.047) and more frequent catheter migration following commencement of PD (12% vs 1%, p = 0.047). There were no significant differences in the rates of overall or infectious complications. Kaplan-Meier estimates of technique survival and time to first episode of peritonitis were comparable between the groups.

Conclusion: Compared with conventional-start PD, urgent-start PD has acceptably low early complication rates and similar long-term technique survival. Urgent-start PD appears to be a safe way to initiate urgent renal replacement therapy in patients without established dialysis access.
Keyword Complications
End-stage kidney disease
Peritoneal dialysis
Peritonitis
Technique survival
Urgent-start
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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